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Carlos Macaya

Publications and source records attributed to Carlos Macaya.

At least 109 records · Page 6Linked to original sources
PubMed2003

Evaluation of myocardial perfusion with grey-scale ultra-harmonic and multiple-frame triggering. The need for quantification.

BACKGROUND AND OBJECTIVE: Contrast echocardiography has been recently introduced as a new technique for evaluating myocardial perfusion in a qualitative basis. The objective of this study was to test whether a visual subjective evaluation of myocardial perfusion by myocardial contrast echocardiography adequately matches the data obtained with an off-line quantification of myocardial perfusion. METHODS: Sixty-one myocardial segments were evaluated by myocardial contrast echocardiography with Ultra-harmonic and Multiframe Triggering in 11 patients 3-7 days after an anterior myocardial infarction, using SH-U 563A (Levovistâ, Schering AG, Berlin, Germany) as contrast agent. Myocardial perfusion was classified as grade 1 (absent), 2 (patchy or incomplete) and 3 (complete) in each segment. The quantitative analysis was performed off-line by a different investigator blinded to the qualitative evaluation, using a commercially available software. The quantitative data on grey-scale obtained were compared between grade 1, 2 and 3 segments. RESULTS: Of the 61 segments, 45 (73.8%) were classified as grade 3, whereas the remaining 16 (26.2%) were considered to be abnormally perfused (grade 2: n=12, 19.6%; grade 1: n=4, 6.6%). Segments with grade 1 perfusion had a significantly higher grey-scale value (123.6 +/- 41.3 vs. 70.1 +/- 34.3, p=0.004). However, there were no significant differences between segments with perfusion grade 2 and 3 (76.8 +/- 33.2 vs. 68.3 +/- 34.8, p=0.452). CONCLUSION: Qualitative assessment of myocardial perfusion by Ultra-harmonic and Multiframe Triggering is of limited value, since only myocardial segments with absent perfusion may be reliably identified. This findings support the need of quantification in the evaluation of myocardial perfusion by contrast echocardiography.

Aged↗
PubMed2003

[Infective endocarditis in patients with chronic liver disease: clinical and prognostic assessment].

INTRODUCTION AND OBJECTIVES: Chronic liver disease increases the susceptibility to bacterial infections and infective endocarditis. Our aim was to determine the clinical and microbiological features and the prognosis in patients with chronic liver disease who also had infective endocarditis. PATIENTS AND METHOD: One hundred and seventy-four consecutive inpatients at our institution were recruited and followed. Thirty of them had chronic liver disease. Clinical, microbiological and echocardiographic variables were analyzed and, in some cases, histological variables were also recorded. RESULTS: Patients with chronic liver disease were younger (36 11 vs 54 18 years; p < 0.01) and had a larger proportion of intravenous drug users (73 vs 16%; p < 0.01), HIV infection (47 vs 10%; p < 0.01), right valve involvement and spleen enlargement, but heart failure appeared less often (7 vs 34%; p = 0.003). Thirty percent of the patients with and 51% of patients without chronic liver disease underwent surgery for infective endocarditis. Total mortality among patients with and without chronic liver disease was 40% and 31%, respectively. After adjustment for age and for the incidence of congestive heart failure, chronic liver disease doubled mid-term mortality with a RR = 2.45 (p = 0.015). CONCLUSIONS: Chronic liver disease has a significant impact on the prognosis in patients with infective endocarditis, and these patients should therefore be considered a high risk group.

Adult↗
PubMed2003

[Hand-held echocardiographic devices: what do they add to the initial cardiovascular evaluation?].

INTRODUCTION AND OBJECTIVES: Hand-held echocardiographic devices have recently become available. Our objective was to determine, on the basis of clinical data and basic diagnostic techniques, whether hand-held devices offer additional information useful not provided by the initial cardiovascular diagnosis. PATIENTS AND METHOD: We prospectively studied the presence and severity (absent, mild, significative) of 7 frequent heart diseases (aortic or mitral stenosis-regurgitation, tricuspid regurgitation, and left ventricular systolic dysfunction-hypertrophy) in 36 consecutive patients (50% men; mean age 68 12 years) with 3 different methods: clinical examination and basic complementary exams, hand-held echocardiography with 2D and color Doppler imaging (OptiGo, Philips Medical Systems, The Netherlands) and a standard, last-generation transthoracic echocardiogram (Sonos 550, Philips Medical Systems, The Netherlands). We compared the results obtained with the first two methods, and combined the results of both to compare these findings against the results obtained with standard electrocardiography. Percentage agreement and Somer's D, a measure of association between ordinal variables, were calculated. RESULTS: The hand-held device obtained better results than clinical examination (agreement 87 vs. 65%; D = 0.79 0.04 vs. 0.19 0.53) and identified severe lesions that were classified incorrectly by clinical examination in 39% (14/36) patients. However, in 8 patients (10 evaluations) it misclassified severe lesions. CONCLUSIONS: In experienced hands, a hand-held echocardiographic device offers additional information not obtained from an initial cardiovascular diagnosis for common cardiovascular disorders, but it is no substitute for complete echocardiographic examination.

Aged↗
PubMed2003

Predictors and implications of residual plaque burden after coronary stenting: an intravascular ultrasound study.

BACKGROUND: Residual plaque burden after coronary stenting may be visualized by use of intravascular ultrasound. Determinants and implications of residual atherosclerotic plaque burden after coronary stenting are not well established. In particular, the implications of residual plaque burden, after adjusting for confounding factors, are still unknown. METHODS: Sixty-two consecutive patients (age 56 +/- 9 years) undergoing coronary stenting under intravascular ultrasound imaging guidance were prospectively studied. A total of 616 slices were analyzed (every 2 mm of stent length) from motorized pull-back recordings. Residual plaque burden was calculated as residual plaque/vessel area x 100. RESULTS: In 565 slices (89%), both residual plaque area and stent area could be measured. Mean residual plaque burden was 46.5% +/- 6%. By use of multiple regression analysis, lesion plaque area and reference segment plaque burden were identified as independent predictors of residual plaque burden after stenting. In addition, a significant correlation was found between residual plaque burden and most relevant angiographic parameters at follow-up (including minimal lumen diameter, percent diameter stenosis, and loss index), which persisted after adjustment. Furthermore, stents with a residual plaque burden >or=46% had higher a restenosis rate (relative risk [RR] 4.4, 95% CI 1.09-18.2, P =.03). On logistic regression analysis, residual plaque burden (RR 4.8, 95% CI 4.1-5.6, P =.01) and diabetes (RR 4.3, 95% CI 3.6-5.1, P =.03) emerged as the only independent predictors of restenosis. CONCLUSIONS: The amount of residual plaque burden after coronary stenting plays an independent role on the late angiographic outcome of these patients.

Coronary Artery Disease↗
PubMed2003

Direct stenting with the Bx VELOCITY balloon-expandable stent mounted on the Raptor rapid exchange delivery system versus predilatation in a European randomized Trial: the VELVET trial.

AIMS: This study examined the six-month angiographic results of direct coronary stenting, and compared the nine-month safety, efficacy and cost of this strategy versus stenting after balloon predilatation. METHODS: In phase I of VELVET, 122 patients (mean age = 62.3 +/- 10.1 years, 77% male, 11% with diabetes) with angina pectoris or myocardial ischemia resulting from a single de novo 51% to 95% coronary stenosis underwent direct stenting. The endpoints of phase I included angiographic findings and rates of major adverse cardiac events up to six months of follow-up. In phase II, 401 patients (mean age = 61.3 +/- 10.8 years, 79% male, 16% with diabetes) with angina pectoris or documented myocardial ischemia resulting from single or multiple, de novo or restenotic, coronary lesions were randomized between direct stenting and stenting after predilatation. The immediate angiographic results, and clinical outcomes and costs associated with the two treatment strategies up to nine months of follow-up were compared. RESULTS: In phase I the mean diameter stenosis immediately before and after the procedure, and at six months was 61.7+/-9.4%, 13.5+/-6.3%, and 33.6+/-16.2%, respectively. The six-month binary restenosis rate was 11%. The overall rate of major adverse cardiac events, including two non-cardiac deaths, was 9.8%. In phase II, the success rates of the intended delivery strategies were 87.9% and 97.9% for direct stenting and predilatation, respectively (p < 0.001), while the procedural success rates were similar (93.9% vs 96.5%). Over a follow-up period of nine months, major adverse cardiac events rates were 12.0% and 10.9% in patients randomized to direct stenting and predilatation, respectively (non-significant). Analyses of the costs incurred up to nine months in each treatment group revealed a mean saving of e362 per patient in favor of the direct stenting strategy (non-significant). CONCLUSIONS: Compared with a strategy of stenting preceded by balloon dilatation, direct stenting was associated with an equivalent procedural success rate, equivalent clinical results up to nine months of follow-up, and a reduction in procedural and in-hospital costs (p < 0.0001 and p < 0.001, respectively), that was no longer significant after nine months.

Angina Pectoris↗
PubMed2003

Relationship between the changes in myocardial perfusion and left ventricular ejection fraction after acute myocardial infarction. Study with myocardial contrast echocardiography.

BACKGROUND AND OBJECTIVE: Myocardial contrast echocardiography has recently been proposed as a valid technique in the evaluation of myocardial perfusion after myocardial infarction. The objective of this study was to evaluate the relation between changes in myocardial perfusion assessed by myocardial contrast echocardiography and left ventricular ejection fraction after myocardial infarction. PATIENTS AND METHODS: We prospectively studied 17 patients with acute myocardial infarction, on whom two echocardiographic studies were performed, at 48-72 hours and at 6 months. Left ventricular ejection fraction and myocardial perfusion were evaluated with myocardial contrast echocardiography (Multiple-Frame Triggering and Harmonic Angio). Basal, medial and distal segments of the interventricular septum (anterior location infarction) and inferior wall (inferior infarction) were assessed. Myocardial perfusion was classified semi-quantitatively as grade 0, 1 or 2 (absent, heterogeneous or homogeneous opacification, respectively), giving a perfusion score. RESULTS: Left ventricular ejection fraction improved in 9 patients (53%), the proportion of grade 0 segments decreasing by 11 +/- 17%; by contrast, this proportion increased by 9 +/- 13% in patients with no improvement in ejection fraction (p = 0.028). Additionally, a significant correlation was observed between changes in ejection fraction and both perfusion score (r = 0.625; p = 0.007) and the proportion of grade 2 segments (r = 0.649; p = 0.005). CONCLUSION: After myocardial infarction, there is a significant relation between changes in left ventricular ejection fraction and myocardial perfusion assessed by myocardial contrast echocardiography with i.v. agents.

Aged↗
PubMed2002

Outcomes at 6 months for the direct comparison of tirofiban and abciximab during percutaneous coronary revascularisation with stent placement: the TARGET follow-up study.

BACKGROUND: Two placebo-controlled trials testing intravenous platelet glycoprotein IIb/IIIa antagonists in the setting of percutaneous coronary revascularisation with intracoronary stents have shown a durable reduction in ischaemic events to 6 months. These trials differed regarding their patient population, IIb/IIIa inhibitor, and reported extent of benefit. Whether a small-molecule agent affecting only the IIb/IIIa receptor would provide a similar outcome for ischaemic events and clinical restenosis at 6 months when directly compared with a monoclonal antibody known to affect several integrin receptors is unknown. METHODS: In 18 countries at 149 hospitals, 4809 patients undergoing elective or urgent stent implantation were randomly assigned a bolus and infusion of tirofiban or abciximab. Patients were followed for 6 months for the occurrence of death, myocardial infarction, and any target-vessel revascularisation. The results at 30 days have been reported previously. FINDINGS: At 6 months the composite endpoint of death, myocardial infarction, and target-vessel revascularisation occurred in 356 (14.8%) patients who received tirofiban and 345 (14.3%) patients who received abciximab (hazard ratio 1.04, 95% CI 0.90-1.21; p=0.591). The rates for the individual endpoints were 191 (8.0%) versus 159 (6.6%) for myocardial infarction (hazard ratio 1.21, 95% CI 0.98-1.50; p=0.074), 26 (1.1%) versus 25 (1.0%) for death (1.04, 0.60-1.80; p=0.893), and 194 (8.1%) versus 208 (8.6%) for target-vessel revascularisation (0.93, 0.77-1.14; p=0.495). INTERPRETATION: At 6 months, tirofiban provided a similar level of overall protection to abciximab against the composite of death, myocardial infarction, and any target-vessel revascularisation.

Abciximab↗
PubMed2002

Fluvastatin for prevention of cardiac events following successful first percutaneous coronary intervention: a randomized controlled trial.

CONTEXT: Percutaneous coronary intervention (PCI) is associated with excellent short-term improvements in ischemic symptoms, yet only three fifths of PCI patients at 5 years and one third of patients at 10 years remain free of major adverse cardiac events (MACE). OBJECTIVE: To determine whether treatment with fluvastatin reduces MACE in patients who have undergone PCI. DESIGN AND SETTING: Randomized, double-blind, placebo-controlled trial conducted at 77 referral centers in Europe, Canada, and Brazil. PATIENTS: A total of 1677 patients (aged 18-80 years) recruited between April 1996 and October 1998 with stable or unstable angina or silent ischemia following successful completion of their first PCI who had baseline total cholesterol levels between 135 and 270 mg/dL (3.5-7.0 mmol/L), with fasting triglyceride levels of less than 400 mg/dL (4.5 mmol/L). INTERVENTIONS: Patients were randomly assigned to receive treatment with fluvastatin, 80 mg/d (n = 844), or matching placebo (n = 833) at hospital discharge for 3 to 4 years. MAIN OUTCOME MEASURE: Survival time free of MACE, defined as cardiac death, nonfatal myocardial infarction, or reintervention procedure, compared between the treatment and placebo groups. RESULTS: Median time between PCI and first dose of study medication was 2.0 days, and median follow-up was 3.9 years. MACE-free survival time was significantly longer in the fluvastatin group (P =.01). One hundred eighty-one (21.4%) of 844 patients in the fluvastatin group and 222 (26.7%) of 833 patients in the placebo group had at least 1 MACE (relative risk [RR], 0.78; 95% confidence interval [CI], 0.64-0.95; P =.01). This result was independent of baseline total cholesterol levels (above [RR, 0.76; 95% CI, 0.56-1.04] vs below [RR, 0.77; 95% CI, 0.57-1.02] the median). In subgroup analysis, the risk of MACE was reduced in patients with diabetes (n = 202; RR, 0.53; 95% CI, 0.29-0.97; P =.04) and in those with multivessel disease (n = 614; RR, 0.66; 95% CI, 0.48-0.91; P =.01) who received fluvastatin compared with those who received placebo. There were no instances of creatine phosphokinase elevations 10 or more times the upper limit of normal or rhabdomyolysis in the fluvastatin group. CONCLUSION: Fluvastatin treatment in patients with average cholesterol levels undergoing their first successful PCI significantly reduces the risk of major adverse cardiac events.

Adult↗
PubMed2002

A multicenter study of the tolerability of tirofiban versus placebo in patients undergoing planned intracoronary stent placement.

BACKGROUND: The use of intravenous glycoprotein IIb/IIIa-receptor antagonists has been shown to improve outcomes in patients undergoing percutaneous transluminal coronary angioplasty (PTCA). Tirofiban has shown benefit in a wide range of patients presenting with acute coronary syndromes. Although this agent has been used in patients undergoing percutaneous coronary intervention, a literature search identified no prospective data comparing tirofiban with placebo in patients undergoing planned intracoronary stent placement. OBJECTIVE: This study examined the tolerability of tirofiban in patients undergoing percutaneous intervention with planned intracoronary stent placement. METHODS: This was a multinational, multicenter, prospective, randomized, double-blind, placebo-controlled trial in patients scheduled to undergo PTCA with planned intracoronary stent placement. Patients were randomized in a 3:2 ratio to receive tirofiban as an intravenous bolus (10 microg/kg over 3 minutes) and maintenance infusion (0.10 microg/kg per minute for 36 hours) or a bolus and infusion of placebo. All patients received periprocedural aspirin and heparin and an optional postprocedural thienopyridine (ticlopidine or clopidogrel). Laboratory and safety monitoring were performed throughout the 36 hours after the procedure and at hour 40 or hospital discharge. The primary end point was the proportion of patients with bleeding, defined according to Thrombolysis in Myocardial Infarction (TIMI) trial criteria. The number of patients with cardiac events (death, myo- cardial infarction, urgent revascularization) during the first 30 days after stent placement was also assessed. RESULTS: Eight hundred ninety-four patients (536 tirofiban, 358 placebo) were enrolled, all of whom received aspirin and heparin periprocedurally and optional ticlopidine or clopidogrel after the procedure. No significant between-group differences were observed in the incidence of TIMI major bleeding (0.2% tirofiban, 0.6% placebo) or any TIMI bleeding (3.2% and 1.7%, respectively). The incidence of TIMI minor bleeding was higher with tirofiban than with placebo (2.8% vs 0.6%). The 30-day incidence of the composite end point of any cardiac event was 3.9% in both groups. CONCLUSIONS: On a background of concomitant aspirin, heparin, and a thienopyridine, tirofiban was generally well tolerated in patients undergoing PTCA with planned intracoronary stent placement. Further investigation is needed to ascertain the optimal dosing of tirofiban and heparin to achieve reductions in ischemic complications of intracoronary stenting with an acceptable incidence of bleeding complications.

Angioplasty, Balloon, Coronary↗
PubMed2002

[Implications of late expansion of self-expanding stents on neointimal response: a serial study with intravascular ultrasound].

INTRODUCTION AND OBJECTIVES: A unique property of self-expanding stents is the continuous force exerted against the vessel wall, which may induce additional arterial damage with implications on restenosis. The main purpose of this study is to evaluate the consequences of late self-expansion of coronary Wallstents. METHODS: Eleven patients with Wallstents implanted in native coronary arteries, in whom baseline, post-stenting, after high pressure balloon inflation and at 6-month follow-up intravascular ultrasound were performed. The stented segments were divided in 2-mm cross-sections, that were analyzed independently and carefully matched at each situation using anatomic landmarks. Multiple regression analysis was performed. RESULTS: Late expansion was present in 93% of the studied sections (mean increase in stent area of 2.0 1.9 mm2) and was clearly related to stent oversizing (r = 0.45; p < 0,0001). Although late expansion was a significant positive predictor of neointimal growth (r = 0.63; p < 0.0001), it showed a negative correlation with late luminal loss (r = 0.33; p < 0.0001). No significant correlation was found between optimization of angiographic results with high pressure inflations and late luminal loss. CONCLUSIONS: Late expansion is a common phenomenon after Wallstent implantation and is mainly determined by stent oversizing. Despite the fact that this phenomenon is associated with greater neointimal proliferation, it seems to have a net beneficial effect on late luminal loss.

Coronary Restenosis↗
PubMed2002

Usefulness of paced activation sequence mapping in catheter ablation of accessory pathways.

INTRODUCTION: Radiofrequency (RF) ablation of accessory pathways (APs) is often a time-consuming procedure, mainly because conventional criteria have modest accuracy. Thus, additional mapping criteria are desirable. Our hypothesis was that comparison of paced atrial activation sequences with that obtained during orthodromic AV reentrant tachycardia might be useful for locating the atrial insertion of single APs. METHODS AND RESULTS: The study included 15 patients with a single AP referred for ablation. Analysis of the atrial activation sequence was simplified by measuring the activation time (AT) that elapsed between two atrial reference points placed next to the AV annulus on either side of the area containing the AP. Ablation was guided by conventional criteria. Before each RF delivery, a short pacing train was delivered from the ablation catheter and, after verification of atrial capture, the AT was compared with the AT obtained during orthodromic tachycardia. Fifty sites of RF delivery were appropriate for analysis. The multivariate model with the highest predictive power included a deviation of AT between pacing and tachycardia < or = 5 msec (P < 0.001), a local AV ratio > or = 1 (P = 0.04), and stability of the local electrogram (P = 0.05). The combination of all these criteria predicted a successful application with high sensitivity, specificity, and positive predictive value (92%, 86%, and 71% respectively). To validate the method prospectively, 10 additional consecutive patients underwent an AP ablation procedure guided by these criteria. CONCLUSION: This technique seems to be highly accurate in selecting the atrial site for RF ablation of single APs.

Accessory Nerve↗
PubMed2002

Treatment of a giant coronary aneurysm with a novel technique: scaffolding (tunnel) stenting to support PTFE-covered stents: insights from intravascular ultrasound.

This report describes a patient with progressive angina and a giant coronary aneurysm in the right coronary artery. Percutaneous treatment was performed using a novel technique consisting of implantation of a long stent that provided scaffolding or bridge for the subsequent implantation of two polytetrafluoroethylene-covered stents. Complete closure of the aneurysm was successfully achieved. In the angiogram performed 3 months later for recurrent angina, a localized narrowing at the distal stent edge (corresponding to severe underexpansion of the stent struts on intravascular ultrasound) was observed. This was successfully treated with balloon angioplasty. The technical details of this new technique are described.

Aged↗
PubMed2000

Clinical and angiographic results with the NIR stent: First International NIR Endovascular Stent Study (FINESS-II).

BACKGROUND: Although safety and efficacy of the NIR trade mark stent have been reported, the long-term angiographic and clinical outcomes have yet to be investigated. The FINESS-II study (First International NIR Endovascular Stent Study) was designed to assess the procedural safety of single 9 and 16 mm NIR stent implantation, the six-month restenosis rate and finally the six- and 12-month clinical outcome of patients treated with this novel coronary stent. METHODS: Patients with angina and a single de novo lesion in a native coronary artery of >3 and <5 mm diameter were included in this multicentre, prospective, observational trial. Clinical follow-up was obtained at one, six and 12 months. Angiography was performed before and after the stent implantation and at six months. The primary endpoint included major adverse cardiac events (death, myocardial infarction and target lesion revascularization) within 30 days after the procedure. Major bleeding complications and subacute stent thrombosis within the first 30 days were also reported as specific endpoints. Secondary endpoints were major cardiac-event-free survival at six- and 12-month follow-up and angiographic restenosis at six months. RESULTS: A total of 156 patients (81% male, mean age 60 +/- 10 years), with stable (54%), unstable (40%) angina pectoris or silent ischemia (6%) were enrolled. The target vessel diameter was 2.94 +/- 0.54 mm. The minimal lumen diameter pre, post and at follow-up was 1.04 +/- 0.32 mm, 2.64 +/- 0.42 mm and 1.88 +/- 0.63 mm, respectively. Restenosis rate according to the >50% diameter stenosis criterion at six month follow-up was 19% (26/136). At 12 months, the event-free survival rate was 83% (two deaths, one Q-wave and three non-Q-wave myocardial infarctions, four bypass surgery and 17 target lesion revascularizations), while 87% of the patients were free of angina pectoris. CONCLUSION: the outcome of the FINESS-II trial is comparable to those observed in previous stent trials (Benestent II), indicating that the coronary NIR stent is safe and effective as a primary device for the treatment of native coronary artery lesions in patients with (un)stable angina pectoris.

Journal Article↗
PubMed1999

Clinical and quantitative angiographic outcomes following elective implantation of the self-expanding Wallstent for longer coronary artery lesions--final results of the Wellstent native study.

BACKGROUND: Implantation of short balloon-expandable stents provides superior clinical and angiographic outcome compared with balloon angioplasty in selected patients. The purpose of the Wellstent study was to evaluate the safety and efficacy of the self-expanding Wallstent combined with aspirin and ticlopidine in patients with stable or unstable angina related to a native coronary lesion up to 45 mm in length. METHODS: 105 patients (111 lesions) with stable (57%) or unstable (43%) angina were included in this prospective multicentre evaluation. Angiography before and after Wallstent implantation and at 6-month follow-up was analysed at the core lab using the CAAS 2 system. The primary end-point was incidence of major adverse cardiac events (MACE) at 30 days. Secondary end-points were angiographic outcome at 6 months and MACE at 6 months and 1 year. RESULTS: Acute procedural success (successful stent implantation with residual stenosis <20%) was achieved in 99%. Mean reference diameter was 3.18 +/- 0.66 mm, minimal luminal diameter was 1.00 +/- 0.50 mm pre- and 2.84 +/- 0.47 mm poststent (diameter stenosis 16 +/- 6%). The mean hospital stay was 2.2 days. At 30 days, 95% of patients were free of MACE. At 6 month and 1 year clinical follow-up, 75% and 71% of patients, respectively, remained free of MACE, the majority of which (19 of 30) were re-interventions at re-angiography. In 90% of eligible patients, MLD at follow-up was 1.65 +/- 0.75 mm (late loss 1.20 +/- 0.66 mm, loss index 0.66), diameter stenosis 42 +/- 15%, with a restenosis rate of 32%. Longer stents were associated with greater luminal loss (P = 0.001) and less-favourable clinical outcome. CONCLUSIONS: Wallstent implantation, combined with aspirin and ticlopidine, achieved excellent acute and 30 day clinical results in a heterogenous high-risk patient group. Clinical outcome at 6 months and 1 year remained good, and most adverse events were re-PTCA during follow-up angiography. The loss index of 0.66 and restenosis rate of 32%, related in part to the use of longer stents, emphasizes the continuing need for effective anti-proliferative therapy.

Journal Article↗
PubMedDate not supplied

Intracoronary brachytherapy following drug-eluting stent failure. It's still not time to hang up the spikes!

Drug-eluting stents (DES) have significantly reduced the incidence of restenosis. Although the results obtained with these novel antiproliferative devices are encouraging, recent reports have shown that DES are not completely immune from restenosis. Therefore, the broad use of DES has inevitably led to a major issue: treatment of DES failure. Intracoronary brachytherapy (IBT) represents an important advancement for treatment of in-stent restenosis (ISR) and has led to important pathophysiological insight on the restenotic process. To date, IBT, when properly used, still represents the gold standard for treatment of ISR. However, experience with IBT is for treatment of ISR occurring with bare metal stents (BMS). Whether IBT may be used with the same safety and efficacy profile as an adjunctive treatment for ISR following DES implantation is still unknown. In this article, we report the outcome of a series of patients with DES failure treated with IBT. IBT for treatment of DES failure was shown to be both safe and efficient and, therefore, until ISR exists, IBT still remains an important player in this growing and even more challenging setting.

Adult↗
PubMedDate not supplied

Multiple congenital coronary artery fistulae draining into the left ventricle.

Coronary artery fistula between a coronary artery and a cardiac chamber is a rare condition, especially when multiple fistulas communicate with the left ventricle. Herein we report a case of an elderly woman with multiple diffuse coronary artery-left ventricular fistulas diagnosed by angiography. Since the coronary artery-cardiac chamber communications were multiple and diffuse neither surgery nor transcatheter coil occlusion was considered in this case.

Adrenergic beta-Antagonists↗